Hemodynamic changes associated with carotid artery interventions.
Carotid artery interventions can be associated with adverse hemodynamic changes, including bradycardia and hypotension. These hemodynamic changes are believed to be caused by direct stimulation of the carotid sinus baroreceptors, mimicking normal physiological response to rises in blood pressure. During open carotid surgery, these hemodynamic changes can be controlled by direct injection of medications that block fast voltage gated sodium channels in the neuron cell membrane, thus preventing depolarization of the presynaptic neuron in the carotid sinus. This form of control is difficult or impossible during percutaneous carotid interventions because direct access to the carotid artery and carotid sinus is not available. This discussion focuses on the cause, effects, and possible treatments for the hemodynamic changes associated with carotid artery stenting procedures.
Cayne
Neal S
NS
Department of Vascular Surgery, NYU Medical Center, New York, NY 10016, USA. neal.cayne@nyumc.org
Rockman
Caron B
CB
Maldonado
Thomas S
TS
Adelman
Mark A
MA
Lamparello
Patrick J
PJ
Veith
Frank J
FJ
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D017704:Baroreflex; D001919:Bradycardia / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D002339:Carotid Arteries / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010138:Pacemaker, Artificial; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D018727:Muscarinic Antagonists